Urinary Epinephrine Sulfate Can Predict Cardiovascular Risk in Moderate-to-Severe OSA: A Metabolomics-Based Study

Area of Science:

• Metabolomics
• Cardiovascular Medicine
• Sleep Medicine

Background:

• Obstructive sleep apnea (OSA) poses significant cardiovascular risks.
• Current indicators for predicting cardiovascular risk in OSA are insufficient.
• Urinary metabolomics offers a novel approach for early risk assessment.

Purpose of the Study:

• To utilize urinary metabolomics to identify early cardiovascular risk markers in patients with moderate-to-severe OSA.
• To investigate metabolic pathway alterations associated with OSA.
• To establish the predictive value of specific metabolites for cardiovascular risk in OSA.

Main Methods:

• Recruited male participants undergoing polysomnography.
• Collected clinical, polysomnography, and urine samples.
• Performed untargeted urinary metabolomics, followed by multivariate and ROC analyses.
• Examined associations between metabolites, clinical indicators, and cardiovascular risk using regression and mediation analyses.

Main Results:

• Identified 65 metabolites across various pathways, including pyrimidine and steroid metabolism.
• Urinary epinephrine sulfate was significantly altered and showed high AUC (0.883) for detecting moderate-to-severe OSA.
• Epinephrine sulfate correlated with OSA severity, hypoxia, arterial stiffness, and Framingham cardiovascular risk.
• Epinephrine sulfate predicted increased Framingham risk and arterial augmentation index, partly mediated by blood pressure.

Conclusions:

• Moderate-to-severe OSA is associated with significant alterations in urinary metabolic pathways.
• Urinary epinephrine sulfate serves as a robust predictor of early cardiovascular risk in OSA patients.
• Metabolomic profiling can enhance cardiovascular risk stratification in OSA.